The Role of Psychotherapy in the Care of Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Abstract

Myalgic encephalomyelitis/chronic fatigue (ME/CFS) is a post-infectious, chronic disease that can lead to severe impairment and, even, total disability. Although the disease has been known for a long time, and has been coded in the ICD since 1969 (G93.3), medical research has not yet been able to reach a consensus regarding its physiological basis and how best to treat it. Against the background of these shortcomings, psychosomatic disease models have been developed and psychotherapeutic treatments have been derived from them, but their empirical testing has led to sobering results. According to the current state of research, psychotherapy and psychosomatic rehabilitation have no curative effect in the treatment of ME/CFS. Nevertheless, we see numerous patients in practices and outpatient clinics who suffer severely as a result of their illness and whose mental well-being and coping strategies would benefit from psychotherapeutic help. In this article, we outline a psychotherapeutic approach that serves this need, taking into account two basic characteristics of ME/CFS: firstly, the fact that ME/CFS is a physical illness and that curative treatment must therefore be physical; and secondly, the fact that post exertional malaise (PEM) is a cardinal symptom of ME/CFS and thus warrants tailored psychotherapeutic attention.

Why the Psychosomatic View on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Is Inconsistent with Current Evidence and Harmful to Patients

“…This can only be achieved if the treating therapist is familiar with ME/CFS. Grande et al [107] describe how supportive psychotherapy in ME/CFS should look like. It is essential that ME/CFS is recognized as an organic disease and that those affected are supported in the implementation of pacing as a disease management strategy.…”

“…Additionally, more and more representatives of psychology, psychiatry, and psychosomatic medicine have started to recognize and address this problem. The integration of supportive psychotherapy on the grounds of a biomedical understanding of ME/CFS into interdisciplinary teams would represent an important step forward in terms of comprehensive care for ME/CFS patients [107]. However, there is still a lot of educational work to be done before this concept reaches the daily care of patients with ME/CFS.…”

Fatigue bei Erwachsenen, Jugendlichen und Kindern - eine klinische Einordnung im pandemischen Kontext

“…Psychotherapeutische Verfahren sind als ursächlicher Behandlungsansatz bei ME/CFS ungeeignet, allerdings kann eine auf die individuellen Bedarfe ausgerichtete psychotherapeutische Begleitung als Bewältigungsstrategie (co-ping) hilfreich sein [8]. Der Nutzen der kognitiven Verhaltenstherapie (KVT) bei ME/CFS wird kontrovers diskutiert: Das IQWIG bewertet die KVT als ein Angebot vor allem an leichter erkrankte Patient*innen, etwas besser mit ihrer Situation zurechtzukommen [7].…”

Systemisches Denken, subjektive Befunde und das diagnostische „Schubladendenken“ bei ME/CFS – Eine vorwiegend qualitative Public-Health-Studie aus Patientensicht

“…Andere vermuten, dass die Symptome bei einer anhaltenden Aktivierung der neurobiologischen Stressreaktion verschiedene Reaktionen des Gehirns auf eine Reihe biologischer, psychologischer und sozialer Faktoren widerspiegeln, was wiederum mit Veränderungen im immunologischen, hormonellen, kognitiven und im Verhaltensbereich verbunden sei 36 . Wiederum andere sehen ME/CFS zwar als somatische Erkrankung an, gehen jedoch davon aus, dass die PEM eine maßgeschneiderte psychotherapeutische Behandlung erfordert 37 .…”